Outcomes of preterm infants born with marginal viability in a University Hospital in Thailand

Abstract

Aim Reports of the outcomes of infants born with marginal viability in developing countries are limited. This study aimed to determine the mortality rate and major disabilities of extremely preterm infants. Methods A retrospective cohort with a prospective part of neurodevelopmental assessment was performed in infants born at 23–25+6 weeks' gestational age (GA) who received active resuscitation and were admitted to neonatal intensive care unit during 2005–2015. Surviving infants were recruited for neurodevelopmental assessment including cognition, gross motor and neurosensory disorders. Major disability was defined as one of the following: severe cognitive impairment, severe cerebral palsy, blindness or deafness. Results A total of 67 infants were enrolled (8, 22 and 37 in the 23, 24 and 25 weeks' GA groups, respectively). The overall mortality rate before discharge was 26%. Infants in the 23 and 24 weeks' GA groups had a significantly higher mortality rate than did those in the 25 weeks' GA group (42 vs. 10%). Of 50 survivors (aged 2–12 years), 3 and 2 had blindness and deafness, respectively. Cognitive function assessment in 37 survivors showed that 4 (11%) and 15 (40%) had severe and borderline cognitive impairment, respectively. Death or major disability was found in 100, 63 and 38% in the 23, 24 and 25 weeks' GA groups, respectively. Conclusion In our centre, infants born at 23–24 weeks had a much higher chance of death or major disability than those born at 25 weeks' GA. Given such information, active management should be offered together with the family's involvement.

Mortality and Comorbidities in Extremely Low Birth Weight Thai Infants: A Nationwide Data Analysis

“…RDS infants require respiratory support, which can cause lung injury in ELBW infants and lead to the long-term development of BPD. This condition was also identified in 32.4% of the study population, which is comparable to previous studies in other developed countries [ 8 , 9 ] as well as prior Thai studies [ 17 , 18 , 19 ], which reported a BPD range of 20–42%.…”

“…There are limited data reporting mortality and morbidities of ELBW infants from low- and middle-income countries [ 5 , 10 , 14 , 15 , 16 ]. In Thailand, there were reports of this high-risk population from University hospitals [ 17 , 18 , 19 ] but no detailed information as the overall view at the country level, which is critical to implement programs for improvement of neonatal outcomes.…”

Prevalence of cognitive dysfunction and its risk factors in children with chronic kidney disease in a developing country

“…The tests used an IQ measure normalized in the U.S., therefore, the tests cannot rule out the possibility that cognitive functioning skewed low because of the cultural bias of the WISC and WAIS. Previous studies of FSIQ measurement in Thai children have been reported, but they used the Thai version of the WISC-III [26][27][28][29][30]. The mean FSIQ using the Thai version of the WISC-III was 93-96, 97, 90, and 79 in healthy children, liver transplant recipients, children with a history of preterm birth, and children with prenatally-acquired human immunodeficiency virus (HIV), respectively [26][27][28][29][30].…”